LRTI in children Flashcards
what is the lower resp tract
airway distal to the larynx
what are LRTI
tracheitis
pneumonia
bronchitis
empyema
bronchiolitis
common infective agents
BACTERIA:
- strep pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
- mycoplasma pnuemoniae
- chlamydia pnuemoniae
VIRAL:
- RSV
- parainfluenza III
- influenza A and B
- adenovirus
how common are LRTI
17% of all hospital admissions
bronchiolitis - 9%
LRTI - 7%
how common is tracheitis
uncommon
features of tracheitis
croup which doesn’t get better
fever, unwell child
what is the infectious agent in tracheitis
staph/strep invasive infection
what happens to the trachea in tracheitis
swollen tracheal wall
narrowed tracheal lumen
luminal debris
management of tracheitis
augmentin
how common is bronchitis
very common ++++
what is bronchitis and what are the features
endobronchial infection
- loose rattly cough w/ URTI
- post-tussive vomit - violent coughing paroxysms are often followed by emesis
- chest free of wheeze/creps
infectious organism in bronchitis
haemophilus
pneumococcus
natural hx of bronchitis
following URTI
lasts 4wks
cycles of resolving and recurring: resp virus, clearance stops for <4wks, cough and rattle, clearance almost recovered, resp virus again (common in winter)
mostly self-limiting
60-80% respond to abx
severity decreases each year
mechanism of bacterial bronchitis
disturbed mucociliary clearance
- minor airway malacia
- RSV/adenovirus
bacterial infection/overgrowth is 2y
normal duration of cough
~50% for 10 days
~20% >2wks
management of bacterial bronchitis
make diagnosis
reassure parents
don’t treat - minimal impact on QOL > abx side effects
what is bronchiolitis
LRTI of infants
infection of the smaller airways
how common is bronchiolitis
30-40% of all infants
commonest cause of LRTI in infancy
peak around 3mths but up to 12mths
infectious organisms in bronchiolitis
RSV
paraflu III
HMPV
features of bronchiolitis
nasal stuffiness
tachypnoea
poor feeding
crackles +/- wheeze
duration of bronchiolitis
when medical attention is sought infant is usually already stabilising
recovery around day 14
50% have symptoms for 12 days
some go on for >16 days
management of bronchiolitis
maximal observation
minimal intervention
no indication for: salbutamol, ipratropium bromide, adrenaline, steroids, abx, nebulised hypertonic saline
investigations for bronchiolitis
NPA
oxygen sats
no routine need for:
- CXR
- bloods
- bacterial cultures
what characterises LRTI
48hrs
fever (>38.5)
SOB, cough, grunting
wheeze makes bacterial cause unlikely
reduced or bronchial breath sounds
infective agents - virus + commensal bacteria
pneumonia vs LRTI
pneumonia if:
- focal signs
- crepitations
- high fever
otherwise call it LRTI
investigations for community acquired pneumonia (CAP)
CXR and inflammatory markers aren’t routine
management of CAP
nothing if symptoms are mild
- review if things get worse
- oral amoxycillin
- oral macrolide e.g. erythromycin if penicillin allergy
- only IV if vomiting
abx - oral vs IV
when to oral abx:
- when indicated
- non-severe LRTI
- no vomiting
- oral abx win majority of the time (shorter hospital stay and cheaper) BUT fever lasts longer
LRTI vs bronchiolitis
LRTI:
- all ages
- more rapid Sx onset
- fever
BRONCHIOLITIS:
- <12mths
- 3 days before reach peak illness
- fever rarely >38C
abx for URTI and LRTI
bronchiolitis - not indicated
croup - not indicated
acute LRTI - often not indicated
OM - usually not indicated (consider if <2y/o and bilateral infection)
pharyngitis/tonsillitis - usually not indicated
causative organism in whooping cough
Bordetella pertussis
how common is pertussis
how can we reduce risk and severity
common (⅓ of children with a cough >14 days have it)
vaccination reduces risk and severity
features of pertussis
coughing fits
vomiting and colour change
what is empyaema
collection of pus in the cavity between the lung and the membrane that surrounds it (pleural space).
what is empyaema a complication of
pneumonia
extension of infection into pleural space
features of empyaema
chest pain and very unwell
treatment of empyema and prognosis
abx +/- drainage
good prognosis - in contrast w/ adults
overall treatment plans for LRTI
- oxygenation, hydration, nutrition
- consider abx if indicated
- tracheitis: augmentin
- bronchitis: not indicated
- LRTI/pneumonia: if 2 days fever, cough, focal signs - oral amoxycillin
- bronchiolitis: not indicated
- empyema: IV amoxycillin
